Brandy Rose-Charlene Wilson-Odom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110009901 Issued in VA

Practice address

125 Nationwide Dr
Lynchburg, VA 24502-4272

Phone

(434) 200-3908

NPI assigned

Feb 29, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centra Medical Group, LLC

  • Family Medicine Physician
  • Lynchburg, VA
  • NPI 1649228966
  Medicare reassignment NPD
• Centra Health Professional Services, LLC

  dba Centra Health Medical Center-Gretna

  • Family Medicine Physician
  • Gretna, VA
  • NPI 1093750861
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1205693942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 BAY HILL DR APT 6",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845644",
            "telephone_number": "231-357-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 NATIONWIDE DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245024272",
            "telephone_number": "434-200-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON-ODOM",
        "first_name": "BRANDY",
        "middle_name": "ROSE-CHARLENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felicia Willis
• Wendy Parsons Willis, PHARMD
• Heather Kristen Willoughby
• James Fount Willson, DO
• Monica Willson, D.O.
• Brandy Wilson, PT
• Courtney Sublett Wilson, MS
• Elizabeth Wilson, LPC
• Emma Wilson
• Jacqui R Wilson, LPTA

• Physician Assistant in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.